The first golden hour

The way your baby is cared for and nurtured immediately after birth significantly impacts their transition from the womb to life outside. In a culture that commonly separates mothers and babies for routine procedures such as cleaning, weighing and measuring, most babies are missing that critical time of being skin to skin with their mothers, which has short and long term consequences for all.

As these procedures are not necessary to maintain or enhance the wellbeing of either mother or baby, there is no reason why they cannot be delayed beyond the first critical hour. The first hour should be focused on baby’s first breastfeed and mother-baby and family bonding. Unless mother or baby is in need of medical assistance, hospital protocols should support this time of new beginnings for both vaginal and caesarean births.

I personally have requested for skin to skin straight after birth and the new born checks are not executed till much later. I was able to bond with Jo2 and Jo3 for at least an hour before the nurses carried them for their newborn checks.

What Is An Undisturbed First Hour?

Babies are born and immediately placed tummy down on their mother’s stomach. A warm blanket should be placed over both mother and baby, to keep mother warm. This slows the production of adrenaline hormone in her so as to not interfere with oxytocin and prolactin hormones being produced (essential for bonding and breastfeeding). At this time, the mother’s needs are simple: warmth and a quiet, calm environment. It is important to remember that she is still in labour – the placenta and membranes are still to be birthed, and her uterus needs to contract down.

At this time, the mother’s needs are simple: warmth and a quiet, calm environment. It is important to remember that she is still in labour – the placenta and membranes are still to be birthed, and her uterus needs to contract down.

Here are 6 important reasons why the first hour after birth should be undisturbed:

#1: Baby-Led Initiation of Breastfeeding

It is quite common these days for hospital staff to want baby to begin breastfeeding within the first hour. In addition to the importance of early feeding for mother-baby attachment and bonding, it also helps to expel the placenta more quickly and easily, reducing the risk of postpartum haemorrhage. It’s common for caregivers to assist baby to latch onto the nipple, which is unnecessary in most cases. When babies who have not been exposed to medications are placed skin to skin with their mothers and left undisturbed, they will instinctually crawl to their mother’s breast and attach themselves to the nipple. This is now known as the ‘breast crawl’ and was first observed by Swedish researchers in the 1980s. Further observation discovered that babies are born with innate instincts that assist them in finding their mother’s nipple, like all newborn mammals. I have noticed that it takes about 30 mins for Jo3 to have the latching instinct so mummies just take your time and do not panic if your baby doesn’t appear to want to latch immediately.

#2: Body System Regulation

Babies who are left skin to skin with their mothers for the first hours immediately after birth are better able to regulate their temperature and respiration. Newborns aren’t able to adjust their body temperature as well as older children and adults as they don’t have the same insulating fat levels. They have spent nine months in an environment that is perfectly temperature controlled. If babies lose too much heat, they have to use more energy and oxygen than they can spare to try and keep their temperature stable An undisturbed first hour with skin to skin also reduces the risk of hypoglycaemia (low blood sugar levels). Newborn babies can produce glucose from their body stores of energy until they are breastfeeding well and are more likely to do so when they remain skin to skin with their mothers.

#3: Promotes Mother-Baby Attachment

Prolonged skin to skin after birth allows mother and baby to get to know each other. Mothers who have skin to skin contact after birth are more likely to feel confident and comfortable in meeting their babies’ needs than those who had none. Attachment is critical to newborn survival and mothers are hard wired to look after their young. Oxytocin receptors in a woman’s brain increase during pregnancy, so when her baby is born, she is more responsive to this hormone that promotes maternal behaviour. Oxytocin is produced in large amounts when breastfeeding and holding babies close skin to skin. Mothers who had early skin to skin with their babies are more likely to demonstrate bonding behaviours later in their child’s life, such as kissing, holding, positive speaking and so on. Skin-to-skin is becoming a reality for more c-section mothers and do as much skin to skin as you can in the first few days will really promote and help with your breastfeeding journey.

#4: Improves Breastfeeding Success Rates

Breastfeeding initiation and duration is likely to be more successful with babies who have early skin to skin contact. The World Health Organization recommends exclusive breastfeeding for babies in the first six months to achieve optimal growth, development and health. Creating the right conditions for the initiation of breastfeeding would help promote longer durations of breastfeeding for many women. Babies who are left to self attach usually have a better chance of proper tongue positioning when latching. This can increase long term breastfeeding as mothers experience more ease and fewer problems when latching is not an issue.

#5: Protects Against The Effects of Separation

Babies are born ready to interact with their mothers – a newborn baby who has not been exposed to excessive medication will be very alert and gaze intently into their mother’s face, recognising her smell, sound of her voice and the touch of her skin. Remaining with their mother is key to a baby’s survival and separation is life threatening. Babies are born with a mammal’s primal instinct to stay within the safe habitat of mother, where there is warmth, safety and nourishment. When babies are separated from their mother they will protest loudly, drawing their mother’s attention to their distress. Babies undergo what is literally a cold turkey withdrawal from the sensory stimulation of their mother’s body. If they are not reunited with their mother despite their protests, they will go into a despair state – essentially giving up and becoming quiet and still. This is partly a survival instinct to avoid attracting predators, and their body systems slow down to preserve energy and heat.

#6: Boost Your Baby’s Immunity

Naturally when babies are born, they emerge from a near-sterile environment in the uterus and are seeded by their mother’s bacteria. This essentially trains the baby’s cells to understand what is ‘good’ and ‘bad’ bacteria. This kickstarts their immune system to fight off infections and protects from disease in the future. Research indicates that if babies aren’t given this opportunity to be exposed to their mother’s bacteria, either because they are not born vaginally, held skin to skin or breastfed, then the baby’s immune system may not reach its full potential and can increase the child’s risk of disease in the future. Skin to skin contact and early breastfeeding is an excellent way to help increase your baby’s exposure to bacteria if you need a caesarean section for medical reasons.

Here are the 9 stages of the golden hour

Why is skin to skin important

Immediate skin to skin for a minimum of one hour after birth is one of the most effective methods for promoting exclusive breastfeeding. Babies who have early skin to skin are more likely to be exclusively breastfed at discharge, exclusively breastfed after discharge, and breastfed for longer durations.Reasons why skin to skin is important for baby and mother:

Keeps mother and baby together.

Promotes bonding between mother and baby.

Provides for earlier initiation of the first breastfeeding experience.

Reduces crying.

Helps baby maintain body temperature better than a hospital warmer, as your body will alter your own temperature to warm or cool the baby to maintain a normal temperature.

Helps regulate baby’s breathing and heart rate.

Helps keep baby’s blood sugar level stable.

Decreases pain for baby from any procedures done while skin-to-skin.

Reduces postpartum haemorrhage in mother.

Can reduce maternal stress and postpartum depression.

Increases the probability of breastfeeding as well as the length of time you will breastfeed your baby beyond the hospital time.

Skin-to-skin right after birth:

Mother is in a slightly reclined position.

Baby is placed on mother’s abdomen, dried, and covered with a blanket until the cord is clamped.

Once the cord is clamped, baby is placed chest-to-chest with mother and remains there uninterrupted for at least one hour and preferably until the first breastfeeding is completed. This provides optimal physiological stability.

Baby’s face is easily visible and uncovered, neck is straight, knees are bent.

Baby may be naked or diapered.

Baby can be dried during process of placing skin-to-skin then baby and mother are covered by a warmed blanket.

Other tests like Apgar scoring can be done while baby is being held skin-to-skin.

Baby’s measurements can be delayed for up to six hours – they are not going to change dramatically in that time frame.

Time in a warmer will not be needed since mother’s body will keep baby warm.

Baby and mother are monitored by nursing staff during skin to skin.

Mother notices baby’s feeding cues, like rooting or sucking on hands, and can guide baby to breast for first feeding.

Skin to skin can continue as mother and baby are moved from the labor suite to the postpartum setting with proper observation for safety.

Continued skin to skin:

Regardless the birth setting – hospital, birth center or home – skin to skin can be part of the normal care of the newborn.

The more that mother and baby are together, the easier it is for mother to recognise baby’s early feeding cues. More frequently baby will breastfeed, and a greater milk volume will be stimulated.

Mothers who “room-in” in the hospital will tend to practice skin to skin more frequently.

Mothers who practice skin to skin report greater confidence in their ability to feed and care for their baby.

Babies who “room-in” have more quiet sleep than those who are separated.

Remember that skin to skin can continue past the birth period and early postpartum. Many mothers have found that snuggling baby skin-to-skin can be soothing at any time and any age.